In connection with surgery for a number of diseases in the gastro-intestinal or urinary tract, a consequence is, in many cases, that the colon, the ileum or the ureter has been exposed surgically and the patient is left with an abdominal stoma, or, in nephrostomy or ureterostomy, the ureter or a catheter is exposed in the back or the chest region or abdominal region, and the effluents or waste products of the body, which are conveyed through these organs, are discharged through the artificial orifice or opening and are collected in a collection bag, which is usually adhered to the skin by means of an adhesive wafer or plate having an inlet opening for accommodating the stoma/ureter/catheter. Also in connection with a fistula, the patient will have to rely on an appliance to collect the bodily material emerging from such opening.
Ostomy appliances are well known. Such appliances may be two-piece or one-piece appliances. In both types of appliances, an adhesive barrier member (or base plate) is attached to the wearer's abdomen/back/chest. In case of a one-piece appliance, a receiving member or bag is permanently attached to the base plate. In case of a two-piece appliance, the adhesive barrier member forms part of a body side member, and a receiving member or bag is attached releasably to the body side ostomy member for receiving exudates from the stoma. When using one-piece appliances, the whole appliance, including the adhesive skin barrier securing the appliance to the skin, is normally removed and replaced by a fresh appliance. When using two-piece appliances, the body side ostomy member is left in place up to several days, and only the receiving member or bag attached to the body side member is replaced. The attachment means for attaching an ostomy receiving bag may for example be a system known per se comprising matching coupling rings or matching flanges and adhesive surfaces engaging with and sealing against a flange area of the body side member.
It is necessary to change the body side member of a two-piece appliance when the centre part of the adhesive wafer has deteriorated to such a degree as to allow access of the aggressive exudates to the skin surrounding the stoma, irrespective of the fact that the wafer as such has a much longer wearing time. The access of aggressive exudates to the skin is causing skin problems. Frequent changing of the body side member of a two-piece appliance is undesirable due to the irritation of the skin, and the quality of life of the user may be improved and the nuisance of the wearing of an ostomy appliance reduced if the intervals between replacing the body side member can be increased
The service time of the body side ostomy member depends inter alia on the amount and the aggressiveness of the exudates and of the sealing between the stoma and the body side ostomy member. The sealing depends on the fit to the stoma. Conventionally, only a limited number of standard appliances having holes of different sizes are available and the user, or an assistant, must customise the body side member by cutting the edge of the hole to adapt the body side member to the stoma.
When cutting the edge of the hole of an adhesive wafer of a conventional one-piece ostomy appliance for adapting it to the size and shape of a stoma, the cutting is complicated by the fact that, in order to secure discretion, for decorative purposes and for providing softness, low noise generation and comfort, the bag is often made from an opaque material or covered and/or provided with a cover or front layer rendering it very difficult, if not impossible for the user or the nurse to observe the stoma area during determination of a cutting line, for adaptation of the hole or when applying the appliance.